Understanding new Medicare rule changes

Medicare recently updated some of the rules that govern certain extra benefits offered by all Medicare health plans. Because these are federal rules, every plan — including Aetna® — must follow them.

As a Dual Eligible Special Needs Plan (D-SNP) member, you have extra benefits to help you manage your health and well-being. One example: an allowance to help pay for certain everyday expenses.

The recent government updates impact how some extra benefits like these are available through all Medicare Advantage plans. The goal is to make sure members receive the extra benefits to support their health condition and improve health outcomes.

We know benefit changes can raise questions. That's why we want to help you understand what's changing and where to find support if you need it.

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Log in to your secure member website to check your personal coverage and benefit costs.

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What to know

You may be hearing soon about upcoming changes. We want to make you aware early and help clear up any confusion.

Eligibility. Beginning in January 2027, Medicare will require plans to add more qualifications for certain benefits connected to a qualifying condition. In addition to having a qualifying chronic condition, the benefits must help to improve the health condition. To help determine eligibility, a plan may use a health risk assessment. And they may look at your medical history.

Extra Benefit Cards. You might only be able to use funds on your Extra Benefits Card for certain over-the-counter products unless you meet all of the new additional criteria. If you meet all of the new criteria, you will be able to use the funds for additional products and services including certain healthy foods, personal care products, transportation and utilities.

What this means for you

Not every member is affected in the same way. You may notice changes to your Extra Benefits Card such as:

• The Extra Benefits Card Wallet allowance
• The products and services you are eligible to receive on your Extra Benefits Card

If changes apply to your Aetna D-SNP benefits, we'll let you know before they take effect. And we’ll explain what they mean for you.

Use digital tools to manage your care

With your online resources, you can access valuable benefit and health info wherever, whenever. Want to see personalized plan details, manage your prescriptions or find a provider, a pharmacy or key forms? Just scan the QR code on your member ID to go to your plan web page.

We’re here for you

We know plan changes can feel disruptive. Let us help support you and clear up any confusion.

There's nothing you need to do today. These changes take effect in 2027.

Have questions? Call the number on your member ID card. We'll help you understand your options and connect you with the resources you need.

You can also sign in to your secure member website to view your plan information, check your benefits and find helpful resources. For instance, your Evidence of Coverage (EOC) and Summary of Benefits. Visit AetnaMedicare.com/LG to log in.

*If you’re a Florida plan member, you can reach your care team at 1-844-498-1860 (TTY: 711), 7 days a week, 8 AM to 11 PM ET.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. The benefit(s) mentioned are part of special supplemental benefits for the chronically ill (SSBCI). SSBCI conditions include certain cardiovascular disorders, congestive heart failure, and diabetes. Eligibility is determined by whether you have a chronic condition associated with the benefit(s). Standards and conditions vary for each benefit. Contact us to confirm the specific SSBCI condition requirements for the benefit(s) for this plan and determine your eligibility. Your Extra Benefits Card, administered by CVS OTC Health Solutions®.

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